Testicular Examination and Testicular Self-Examination (TSE)

Test Overview

Testicular examination and testicular self-examination (TSE) are two methods to detect lumps or abnormalities of the testicles.

The two testicles, or testes, are inside the scrotum. The testicles are the male reproductive organs that produce sperm and the male hormone testosterone. Each testicle is about the size and shape of a small egg. At the back of each testicle is the epididymis, a coiled tube that collects and stores sperm.

The testicles develop within the abdomen of a male baby (fetus) and normally descend into the scrotum before or shortly after birth. A testicle that has not descended can increase the risk for testicular cancer.

Testicular examination

A testicular examination includes a complete physical exam of the groin and genital organs (penis, scrotum, and testicles) by your doctor. Your doctor will feel (palpate) the organs and examine them for the presence of lumps, swelling, shrinking (testicular atrophy), or other visual signs of an abnormality. A testicular examination can detect the causes of pain, inflammation, swelling, congenital abnormalities (such as an absent or undescended testicle), and lumps or masses that may indicate testicular cancer.

A genital exam is an important part of a routine physical exam for every teenage boy and man. Baby boys should also have their genitals checked for congenital abnormalities or an undescended testicle. An undescended testicle is more common in premature male babies than in full-term male babies.

Testicular cancer is rare, but it is the most common cancer in men younger than age 35. Many testicular cancers are first discovered by men themselves, or by their sex partners, as a lump or enlarged swollen testicle. In the early stages of testicular cancer, the lump, which may be about the size of a pea, usually is not painful. Testicular cancer found early and treated promptly has a very high cure rate.

Testicular self-examination (TSE)

Testicular self-examination (TSE) may detect testicular cancer at an early stage. Many testicular cancers are first discovered by self-examination as a painless lump or an enlarged testicle.

Why It Is Done

Testicular examination

A testicular examination may detect the causes of pain, inflammation, swelling, congenital abnormalities (such as an absent or undescended testicle), and lumps or masses in the testicles.

Testicular self-examination (TSE)

Testicular self-examination (TSE) is done to familiarize a man with the normal size, shape, and weight of his testicles and the area around the scrotum. This allows him to detect any changes from normal.

How To Prepare

No special preparation is needed before a testicular examination by your doctor. But for comfort, you should empty your bladder ahead of time. You will be asked to undress and put on a hospital gown.

Testicular self-examination (TSE) is painless and takes only a minute. It is best performed after a bath or shower, when the scrotal muscles are warm and relaxed.

How It Is Done

Testicular examination

The examination may be done initially while you are lying down, then repeated while standing. Your doctor will inspect your abdomen, groin, and genital area (penis, scrotum, testicles). The scrotum and both testicles will be felt (palpated) for their size, weight, texture, and consistency and for physical signs of swelling, lumps, or masses. The absence of one testicle usually indicates an undescended testicle. Shrinking (atrophy) of one or both testicles will also be noted.

If a mass is found in a testicle, your doctor will place a strong light behind the testicle to see whether light can pass through it (called transillumination). A testicular tumor is too solid for light to pass through it. Also, a testicle with a tumor generally appears heavier than a normal testicle. A palpable mass or swelling caused by a hydrocele will allow light to pass through it. A hydrocele feels like water in a thin plastic bag. The other testicle also will be felt and examined to make sure it does not contain any lumps, masses, or other abnormalities.

Your doctor will also feel the lymph nodes in your groin and along your inner thigh for signs of enlargement.

Testicular self-examination (TSE)

TSE is best performed after a bath or shower, when the scrotal muscles are warm and relaxed. If you do the exam at another time, remove your underwear so that your genitals are exposed.

Stand and place your right leg on an elevated surface about chair height. Then gently feel your scrotal sac until you locate the right testicle. Roll the testicle gently but firmly between your thumb and fingers of both hands, carefully exploring the surface for lumps. The skin over the testicle moves freely, making it easy to feel the entire surface of the testicle. Repeat the procedure for the other side, lifting your left leg and examining your left testicle. Feel the entire surface of both testicles.

How It Feels

A testicular examination by your doctor may cause mild discomfort if your testicles are painful, swollen, or inflamed. Whenever the genital area is touched, there is a possibility your body will react, and you may have an erection. This is a normal response that your doctor is aware of and you do not need to feel embarrassed.

Usually there is no pain or discomfort associated with a testicular self-examination (TSE) unless a testicle is swollen or tender. A cancerous lump usually is firm to the touch and usually is not tender or painful when pressed.

Risks

There are no risks linked with a testicular examination or testicular self-examination (TSE). But false-positive results may lead to diagnostic tests or procedures that you don't need.

Results

Testicular examination and testicular self-examination (TSE) are two methods to detect lumps or abnormalities of the testicles.

Testicular examination and testicular self-examination (TSE)

Normal:

Each testicle should feel firm but not hard, and the surface should be very smooth, without any lumps or bumps. The spongy, tube-shaped structure (epididymis) may be felt on the top and down the back side of each testicle. One testicle (usually the left) may hang slightly lower than the other, and one testicle may be slightly larger than the other. This difference is usually normal.

No pain or discomfort is experienced during testicular examination or TSE.

Abnormal:

A small, hard lump (often about the size of a pea) is felt on the surface of the testicle, or the testicle is swollen or enlarged. If you notice a lump or swelling during TSE, contact your doctor immediately. Do not delay or wait for the lump to go away, because it may be an early sign of testicular cancer. Immediate treatment provides the best chance for a cure.

One or both testicles are not felt. If you cannot feel one or both testicles while performing TSE, contact your doctor. This may mean an undescended testicle.

A soft collection of thin tubes (often referred to as a "bag of worms" or "spaghetti") is felt above or behind the testicle. This may mean a varicocele.

Sudden (acute) pain or swelling in the scrotum that is noticed during the testicular examination or TSE may mean an infection (epididymitis) or blockage of blood flow to the testicle (testicular torsion), either of which requires immediate medical evaluation.

A free-floating lump in the scrotum that is not attached to a testicle may be present but is not a cause for concern.

If you cannot feel both testicles in your baby's scrotum (descended), talk to his doctor.

What Affects the Test

There is nothing that interferes with a testicular examination or testicular self-examination (TSE).

What To Think About

Undescended testicles may be a risk factor for testicular cancer. Parents should check their children or have them checked by a doctor to be sure that both testicles have descended properly before puberty.

Experts have different recommendations for screening for testicular cancer . For example, the U.S. Preventive Services Task Force (USPSTF) advises against routine testicular exam or testicular self-exams in teens and men who have no symptoms.1 The USPSTF says that the evidence shows that these exams have only a small benefit and may cause harm from false-positive results that lead to having diagnostic tests or procedures you don't need.

To learn more about the diagnosis and treatment of testicular cancer, see the topic Testicular Cancer.

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